Lymphatic‐venous anastomosis for the treatment of refractory lymphatic ascites following radiation therapy: A case report

Abstract

Radical treatments for intra‐abdominal malignancies disturb physiological lymphatic drainage and predispose the patients to lymphatic complications such as lymphatic ascites. Despite its infrequent occurrence, lymphatic ascites is a morbid complication, and a definitive treatment protocol for refractory cases has not been established. Surgical treatments are opted depending on the etiology, symptoms, and facility equipment. Lymphatic‐venous anastomosis (LVA) bypasses the proximal lymphatic blockages and provides an alternative route for lymphatic fluid recirculation into the venous system, thereby improving the lymphatic congestion. Herein, we report the utility of LVA surgery in the treatment of refractory serous lymphatic ascites that developed after radiation therapy for cervical cancer in a 77‐year‐old woman. The patient had massive ascites and suffered from abdominal distention and anorexia for 1 year. The ascites was unresponsive to conservative treatment. Under local anesthesia, eight incisions were made in the lower extremities just above the lymphatic channels that were identified by indocyanine green lymphography, and a total of 14 LVAs were created. The postoperative course was uneventful, and the ascites improved significantly. The patient remained free from the recurrence of ascites during 3.5 years of postoperative follow‐up. LVA surgery was effective for the improvement and long‐term control of lymphatic ascites. This procedure may be a viable option for the management of lymphatic ascites.

Microsurgical central lymphatic reconstruction—the role of thoracic duct lymphovenous anastomoses at different anatomical levels

“…Besides end-to-end TD anastomosis or TD-vein anastomosis as described in the present case series, other surgical techniques such as lymph node-to-vein anastomosis to treat chylothorax have been suggested (36). Moreover, performing multiple LVAs on the lower extremity has been suggested to bypass proximal lymphatic impairment in patients suffering from recurrent chylous and lymphatic ascites (15,37). Another microsurgical treatment approach for refractory ascites is the creation of LVAs between lymphatic vessels and veins of the greater omentum in the abdomen (38).…”